tag:blogger.com,1999:blog-549949223388475481.post4532159582501355764..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Woman in her 60's with 1 hour of chest painUnknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-549949223388475481.post-84861321419779355052015-11-12T14:31:42.193-06:002015-11-12T14:31:42.193-06:00 Sam,
I do not see any ST elevation on the prehos... Sam, <br />I do not see any ST elevation on the prehospital EKGs.<br /> I think that the reason there is no ST elevation in either AVL or in III is that this was both inferior and high lateral. They cancel each other out.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-11148705234227209832015-11-12T12:13:06.524-06:002015-11-12T12:13:06.524-06:00Steve- this is an excellent case. A few observatio...Steve- this is an excellent case. A few observations:<br /><br />You write "T inversions in I and aVL are present in spite of absence of clear evidence of injury on the previous ECGs". <br /><br />1. If you look closely there is indeed subtle ST-Elevations in I & AVL on the prehospital ECG.<br />2. The T-Waves in the leads are clearly Hyperacute. The shear fact that they are upright given the remainder of the ECG (which is consistent with acute occlusion) implies direct injury. (as opposed to reciprocal hyperacute T-Waves that are inverted)<br />3. In light of the above, the 3rd ECG makes complete sense in terms of global reperfusion T-wave morphology. <br />4. I suspect there was no persistent lateral echo wall motion thanks to the Ramus Intermedius. <br />5. I presume also that the akinetic distal inferior wall may not have large enough to cause inferior STEMI findings. <br /><br />SamAnonymoushttps://www.blogger.com/profile/09692498213534558770noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-1047764677950518332013-05-31T10:34:06.775-05:002013-05-31T10:34:06.775-05:00Thank you for explaining the anomaly, very interes...Thank you for explaining the anomaly, very interesting.<br /> paramedic 2010https://www.blogger.com/profile/04398141025194943367noreply@blogger.com